Provider Demographics
NPI:1588256390
Name:AMBASSADOR ADULT FAMILY HOME LLC
Entity type:Organization
Organization Name:AMBASSADOR ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:NAISIAE
Authorized Official - Last Name:NKURRUNA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-329-8057
Mailing Address - Street 1:PO BOX 30238
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3003
Mailing Address - Country:US
Mailing Address - Phone:509-329-8057
Mailing Address - Fax:
Practice Address - Street 1:5220 S SMITH CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7500
Practice Address - Country:US
Practice Address - Phone:509-329-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1629667605OtherNPPES